24 NEPHRON SPARING SURGERY FOR THE TREATMENT OF SMALL RENAL MASSES: COMPARISON BETWEEN OPEN PARTIAL NEPHRECTOMY, LAPAROSCOPIC PARTIAL NEPHRECTOMY AND LAPAROSCOPIC CRYOABLATION

Introduction. Most of the kidney masses are being detected incidentally with smaller size due to widespread use of imaging modalities leading to increased RCC incidence worldwide with an earlier stage. This article reviews the role of open partial nephrectomy (PN) in the management of small renal masses.Material and Methods. Review of the English literature using MEDLINE has been performed between 1963–2008 on small renal masses, partial nephrectomy, kidney cancer, nephron sparing surgery (NSS), radical nephrectomy, laparoscopy, and surgical management. Special emphasis was given on the indications of NSS, oncological outcomes and comparison with open and laparoscopic PN.Results. Overall 68 articles including 31 review papers, 35 human clinical papers, 1 book chapter, and 1 animal research study were selected for the purpose of this article and were reviewed by the authors.Conclusions. Currently, open NSS still remains as the gold standard surgical treatment modality in patients with small renal masses.

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Nephron-Sparing Surgery: Laparoscopic Partial Nephrectomy

Renal Cell Cancer ◽

10.1007/978-1-84628-763-3_22 ◽

2008 ◽

pp. 221-227

Author(s):

Georges-Pascal Haber ◽

Jose R. Colombo ◽

Inderbir S. Gill

Keyword(s):

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Nephron Sparing Surgery ◽

Nephron Sparing

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Intraoperative ultrasound in robot-assisted partial nephrectomy: State of the art

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2018.3.195 ◽

2018 ◽

Vol 90 (3) ◽

pp. 195-198 ◽

Cited By ~ 3

Author(s):

Giacomo Di Cosmo ◽

Enrica Verzotti ◽

Tommaso Silvestri ◽

Andrea Lissiani ◽

Roberto Knez ◽

...

Keyword(s):

Partial Nephrectomy ◽

State Of The Art ◽

Short Review ◽

Robot Assisted ◽

Small Renal Masses ◽

Renal Masses ◽

Ischemia Time ◽

Oncological Safety ◽

Nephron Sparing ◽

Operative Ultrasound

Introduction: Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the procedure. Aim of this short review is to report the state of the art of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during robotassisted partial nephrectomy (RAPN). Material and methods: We performed a literature review by electronic database on Pubmed about the use of intra-operative US in RAPN to evaluate the usefulness and the feasibility of this procedure. Results: Several studies analyzed the use of different US probes during RAPN. Among them some focused on using contrastenhanced ultra sonography (CEUS) for improving the dynamic evaluation of microvascular structure allowing the reduction of ischemia time (IT). We reported that nowaday the use of intraoperative US during RAPN could be helpful to improve the preservation of renal tissue without compromising oncological safety. Moreover, during RAPN there is no need for assistant to hand the US probe increasing surgeon autonomy. Conclusions: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure. Moreover US could be useful to reduce ischemia time (IT). The advantages of nephron-sparing surgery over radical nephrectomy is well established with a pool of data providing strong evidence of oncological and survival equivalency. With the progressive growth of robot-assisted partial nephrectomy (RAPN) techniques, the use of several tools has been progressively developed to help the surgeon in the identification of masses and its vascular net. In this short review we tried to analyze the current use of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during RAPN.

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